Peer-led HIV Prevention Education

Peer-led HIV Prevention Education employed high school
peers to educate high school students around a variety of HIV-related topics,
including HIV transmission and prevention knowledge, risk perception, and
prevention, communication, and negotiation skills. Using an adapted version of
the Healthy Oakland Teens Peer-led AIDS Prevention Curriculum and implemented in
Rome, Italy, the program randomly assigned 9 high schools to receive peer-led
HIV instruction while the other 9 high schools received teacher-led HIV
instruction. The program spanned a total of 10 hours, which were broken down
into 5 sessions. At the 5-month post-test, classrooms receiving peer-led
instruction exhibited significant improvement in their knowledge score compared
with teacher-led instruction. However, there were no impacts on attitudes, risk
perception, and prevention skills. There were also no impacts on condom usage or
number of sexual partners within the past 3 months.

DESCRIPTION OF PROGRAM

Target population: High school students.

Peer-led HIV Prevention Education employs high school peers
to educate high school students around a variety of HIV-related topics,
including HIV transmission and prevention knowledge, risk perception, and
prevention, communication, and negotiation skills. Using an adapted version of
the Healthy Oakland Teens Peer-led AIDS Prevention Curriculum and implemented in
Rome, Italy, and based on Social Learning Theory, the program spans a total of
10 hours, which were broken down into 5 sessions. Peers, selected from each
class, were chosen by teachers and other experts, based on a variety of personal
characteristics: charisma, credibility, communication and relationship-building
skills. Peer leaders attend a 5-day training, led by psychologists.
Additionally, teachers, selected by the school headmaster, attend a 6-hour
training led by healthcare workers.

Evaluated population: 1,295 students, from 18 high
schools in Rome, Italy, comprised the study sample, with a median age of 18
years, and one-half (51%) were sexually active at baseline. After school
randomization, 613 students were slotted to receive peer-led HIV education
instruction while the remaining 682 students were to receive the teacher-led HIV
education instruction.

Approach: Schools were randomly assigned to either
receive the peer-led (n=9) or teacher-led (n=9) HIV education curriculum.
Impacts were evaluated through self-administered questionnaires, which assessed:
sexual behavior over time and within past 3 months, including condom usage and
number of sexual partners; knowledge of HIV transmission and prevention;
prevention, communication, negotiation skills; risk perception; and attitudes
towards persons living with AIDS. Questionnaires were distributed at pre-test,
prior to the education program, as well as five months after the education
program, at post-test.

Results: Among the peer-led group, there was a
significant improvement in the knowledge score compared with the teacher-led
group. However, there were no significant differences between the teacher-led
and peer-led groups with changes in attitudes, risk perception, and prevention
skills. There were also no significant differences between the peer-led and
teacher-led groups in student-reported condom use or number of sexual partners
in the past 3 months.

While both teacher-led and peer-led classes experienced
attrition, the percentage was higher among the teacher-led classrooms (27%)
compared with the peer-led classrooms (20%). Questions were also raised about
the method used in selecting peer leaders, and the authors acknowledge the
possibility that some peer leaders were nominated by teachers based on high
academic grades rather than communication and relationship-building skills.
Furthermore, the authors conclude that, while peer leaders were more effective
in improving knowledge, it was costlier to implement peer-led instruction than
teacher-led instruction and therefore recommend additional cost-effective
analyses. It should be noted that both approaches were related to increases over
time in knowledge, skills, attitudes, and perception of risks, however.